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Now, Keenan, who uses female pronouns, is making history.

Hers is believed to be the first birth certificate ever issued in the United States that reads “intersex” in the gender field, instead of “male” or “female.”Lambda Legal attorney Paul Castillo commended the New York City agency “for issuing an accurate birth certificate.”“In the United States, birth certificates often provide access to a wide range of public services and critical identity documents, such as state IDs and passports,” Castillo said.

But her success in gaining legal third-gender documents is forcing all levels of government to act, as they scramble to accommodate terms that many state and federal agencies don’t currently use in their computer systems.

In September, Keenan made headlines when a judge allowed her to become the first California resident to change her gender to “non-binary.” When the New York City Department of Health and Mental Hygiene (DOHMH) issued her new birth certificate, she entered truly unique territory: Keenan now has two legal genders, both issued this year.

The third-gender momentum gained by Keenan and other intersex people follows on the heels of decades of transgender activism that made it easier for people to change gender markers on identity documents.

In 2016, it is relatively simple—with the appropriate medical care and documentation—in most states to change one’s gender from male to female and vice versa.

That case, kept quiet for privacy reasons, ironically owed its victory to the same law that makes it impossible for transgender Ohio natives to change their birth certificates: a 1987 ruling that states "a birth certificate is an historical record of the facts as they existed at the time of birth." The person who was issued the revised certificate was able to provide medical documentation showing they were born “a true hermaphrodite” according to medical terminology.

Keenan is certainly not the first intersex person to fight for recognition on identity documents.

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Back then, intersex people were called “hermaphrodites,” and doctors typically recommended surgery to make them conform to one of two genders.

And I appreciated a different one's honest response after I disclosed the truth: "If you are actually that height [5'4"] then I probably wouldn't be attracted to you." She was attracted to me at first, at least enough to type 126 words in her first reply.

We paid the money for a room with lots of mirrors, went in, started making out on the bed, and then just as we were about to, as they say, consummate matters, she looked up at me and asked, I was like, What the hell? And you know I’m not trying to lead anybody on, but for Christ’s sake. Okay, so I haven’t dated that many Japanese women, statistically speaking.